Altered Gut Microbiome in Parkinson's Disease and the Influence of Lipopolysaccharide in a Human α-Synuclein Over-Expressing Mouse Model

The interaction between the gut microbiota and alpha-synuclein (αSyn) aggregation in Parkinson’s disease (PD) is receiving increasing attention. The objective of this study was to investigate gut microbiota, and effects of an inflammatory lipopolysaccharide (LPS) trigger in a human αSyn over-expressing mouse model of PD (Thy1-αSyn). Stool samples from patients with confirmed PD and Thy1-αSyn mice were analyzed using 16S ribosomal RNA sequencing. Compared to healthy controls, the relative abundance of mucin-degrading Verrucomicrobiae and LPS-producing Gammaproteobacteria were greater in PD patients. In mice, the abundance of Gammaproteobacteria was negligible in both Thy1-αSyn and wild-type (WT) animals, while Verrucomicrobiae were reduced in Thy1-αSyn mice. The effect of LPS on intestinal barrier function was investigated in vitro using intestinal epithelial (IEC-6) cells, and in vivo via administration of LPS in drinking water to Thy1-αSyn mice. Acute exposure to LPS in vitro resulted in a reduction and altered distribution of the tight junction markers ZO-1 and e-Cadherin around the cell membrane in IEC-6 cells, as shown by immunohistochemistry. LPS administration in Thy1-αSyn mice resulted in the emergence of early motor manifestations at 10 weeks, compared to untreated mice who were still asymptomatic at this age. This study reaffirms that an altered microbiome exists in patients with PD, and supports the notion of a proinflammatory gut microbiome environment as a trigger for PD pathogenesis.

Globus pharyngis: development of a symptom assessment scale

One hundred and five consecutive patients attending an ENT out-patients' clinic with a diagnosis of globus pharyngis completed a 10-item questionnaire concerning common throat symptoms. Principal components analysis of the questionnaire revealed a general throat pathology factor, and three orthogonal rotated factors which were related to dysphagia, globus sensation, and pain/swelling in the throat. Of 10 throat symptoms, the globus patients most commonly complained of: "Feeling of something stuck in the throat," "Discomfort/irritation in the throat," and "Want to swallow all the time." These were the symptoms which had highest loadings on the 'globus' factor. The clear factor structure and the satisfactory internal consistency of the Glasgow-Edinburgh Throat Scale (GETS) suggest that it offers a clinically useful instrument for assessing and monitoring the severity of some common throat ailments. The degree of distress caused by throat symptoms was predicted independently by the intensity of the globus sensation and by anxiety level.

Caring--a masculine perspective

The last decade has witnessed an increase in the published works dedicated to the issue of men and their masculinity. While the views are divergent, the overwhelming image of masculine identity today remains the traditional one. This traditional masculinity is underpinned by oppressive practices affecting women, gay men and black men. Within nursing, it would appear that men are assuming positions of power in ever increasing numbers and that these men tend to follow traditional masculine paths. Thus a situation is arising where a profession that consists overwhelmingly of women is being dominated by men being in positions of power. If these men occupy the traditional masculine standpoint then this may have a negative impact on care.

The Neuroprotective Peptide Poly-Arginine-12 (R12) Reduces Cell Surface Levels of NMDA NR2B Receptor Subunit in Cortical Neurons; Investigation into the Involvement of Endocytic Mechanisms

We have previously reported that cationic poly-arginine and arginine-rich cell-penetrating peptides display high-level neuroprotection and reduce calcium influx following in vitro excitotoxicity, as well as reduce brain injury in animal stroke models. Using the neuroprotective peptides poly-arginine R12 (R12) and the NR2B9c peptide fused to the arginine-rich carrier peptide TAT (TAT-NR2B9c; also known as NA-1), we investigated the mechanisms whereby poly-arginine and arginine-rich peptides reduce glutamate-induced excitotoxic calcium influx. Using cell surface biotin protein labeling and western blot analysis, we demonstrated that R12 and TAT-NR2B9c significantly reduced cortical neuronal cell surface expression of the NMDA receptor subunit NR2B. Chemical endocytic inhibitors used individually or in combination prior to glutamate excitotoxicity did not significantly affect R12 peptide neuroprotective efficacy. Similarly, pretreatment of neurons with enzymes to degrade anionic cell surface proteoglycans, heparan sulfate proteoglycan (HSPG), and chondroitin sulfate proteoglycan (CSPG), as well as sialic acid residues, did not significantly affect peptide neuroprotective efficacy. While the exact mechanisms responsible for R12 peptide-mediated NMDA receptor NR2B subunit cell surface downregulation were not identified, an endocytic process could not be ruled out. The study supports our hypothesis that arginine-rich peptides reduce excitotoxic calcium influx by reducing the levels of cell surface ion channels.

Mitochondria and neuroprotection in stroke: Cationic arginine-rich peptides (CARPs) as a novel class of mitochondria-targeted neuroprotective therapeutics

Stroke is the second leading cause of death globally and represents a major cause of devastating long-term disability. Despite sustained efforts to develop clinically effective neuroprotective therapies, presently there is no clinically available neuroprotective agent for stroke. As a central mediator of neurodamaging events in stroke, mitochondria are recognised as a critical neuroprotective target, and as such, provide a focus for developing mitochondrial-targeted therapeutics. In recent years, cationic arginine-rich peptides (CARPs) have been identified as a novel class of neuroprotective agent with several demonstrated mechanisms of action, including their ability to target mitochondria and exert positive effects on the organelle. This review provides an overview on neuronal mitochondrial dysfunction in ischaemic stroke pathophysiology and highlights the potential beneficial effects of CARPs on mitochondria in the ischaemic brain following stroke.

The Path to Progress Preclinical Studies of Age-Related Neurodegenerative Diseases: A Perspective on Rodent and hiPSC-Derived Models

Alzheimer's disease (AD) and Parkinson's disease (PD) are the two most prevalent age-related neurodegenerative diseases, and currently no effective clinical treatments exist for either, despite decades of clinical trials. The failure to translate preclinical findings into effective treatments is indicative of a problem in the current evaluation pipeline for potential therapeutics. At present, there are no useful animal models for AD and PD research that reflect the entire biology of the diseases, specifically, the more common non-Mendelian forms. Whereas the field continues to seek suitable rodent models for investigating potential therapeutics for these diseases, rodent models have still been used primarily for preclinical studies. Here, we advocate for a paradigm shift toward the application of human-induced pluripotent stem cell (hiPSC)-derived systems for PD and AD modeling and the development of improved human-based models in a dish for drug discovery and preclinical assessment of therapeutic targets.

Altered dental sensation following intranasal surgery

Some patients complain of altered sensation in the mouth following nasal surgery. A prospective study of 60 consecutive patients who underwent a total of 83 intranasal procedures revealed that this was a common complication, particularly following submucous resection (SMR) or intranasal antrostomies. The area affected by pain/parasthesia appears to be anatomically related to the surgical procedure(s) performed.

Audit of the treatment of tonsillar and peritonsillar sepsis in an ear, nose and throat unit

We became aware that a range of antibiotics were being used in our unit to treat patients suffering from tonsillitis or peritonsillar abscess (quinsy). There appeared to be no rationale to determine which antibiotics were used, and we felt that we were possibly using expensive antibiotics when cheaper equally effective ones were available. An audit project was therefore devised to establish the current practice in the ENT Unit at the City Hospital at Edinburgh. Following a six-month prospective pilot study, a protocol for the treatment of tonsillar and peritonsillar sepsis was drawn up and subsequent practice and outcome was then audited, thus completing the audit cycle. As a result substantial savings in the cost of prescribed antibiotics have been made without compromising patient care.

Proteomic analysis of cortical neuronal cultures treated with poly-arginine peptide-18 (R18) and exposed to glutamic acid excitotoxicity

Poly-arginine peptide-18 (R18) has recently emerged as a highly effective neuroprotective agent in experimental stroke models, and is particularly efficacious in protecting cortical neurons against glutamic acid excitotoxicity. While we have previously demonstrated that R18 can reduce excitotoxicity-induced neuronal calcium influx, other molecular events associated with R18 neuroprotection are yet to investigated. Therefore, in this study we were particularly interested in protein expression changes in R18 treated neurons subjected to excitotoxicity. Proteomic analysis was used to compare protein expression patterns in primary cortical neuronal cultures subjected to: (i) R18-treatment alone (R18); (ii) glutamic acid excitotoxic injury (Glut); (iii) R18-treatment and glutamic acid injury (R18 + Glut); (iv) no treatment (Cont). Whole cell lysates were harvested 24 h post-injury and subjected to quantitative proteomic analysis (iTRAQ), coupled with liquid chromatography-tandem mass spectrometry (LC-MS/MS) and subsequent bioinformatic analysis of differentially expressed proteins (DEPs). Relative to control cultures, R18, Glut, and R18 + Glut treatment resulted in the detection of 5, 95 and 14 DEPs respectively. Compared to Glut alone, R18 + Glut revealed 98 DEPs, including 73 proteins whose expression was also altered by treatment with Glut and/or R18 alone, as well as 25 other uniquely regulated proteins. R18 treatment reversed the up- or down-regulation of all 73 Glut-associated DEPs, which included proteins involved in mitochondrial integrity, ATP generation, mRNA processing and protein translation. Analysis of protein-protein interactions of the 73 DEPs showed they were primarily associated with mitochondrial respiration, proteasome activity and protein synthesis, transmembrane trafficking, axonal growth and neuronal differentiation, and carbohydrate metabolism. Identified protein pathways associated with proteostasis and energy metabolism, and with pathways involved in neurodegeneration. Collectively, the findings indicate that R18 neuroprotection following excitotoxicity is associated with preservation of neuronal protein profiles, and differential protein expression that assists in maintaining mitochondrial function and energy production, protein homeostasis, and membrane trafficking.

Massive cutaneous large cell T-cell non-Hodgkin's lymphoma of the pinna

We report a patient with a cutaneous large cell T-cell non-Hodgkin's lymphoma of the pinna, a condition that has not been reported before. Despite the large dimensions of the tumour, the patient's ear was restored by electron therapy.

Microglia are both a source and target of extracellular cyclophilin A

Glioblastoma (GBM) are lethal primary brain tumours whose pathogenesis is aided, at least partly, via a pro-tumorigenic microenvironment. This study investigated whether microglia, a cell component of the GBM microenvironment, mediates pro-tumorigenic properties via the action of cyclophilin A (CypA), a potent secretable chemokine and cytoprotectant that signals via the cell surface receptor, CD147. To this end, intracellular and secreted CypA expression was assessed in human primary microglia and BV2 microglial cells treated with the endotoxin, lipopolysaccharide (LPS) and the oxidative stress inducer, LY83583. We report that human primary microglia and BV2 microglia both express CypA and CD147, and that BV2 microglial cells secrete CypA in response to pro-inflammatory and oxidative stimuli. We also demonstrate for the first time that recombinant CypA (rCypA; 1nM-1000nM) dose-dependently increased wound healing and reduced basal cell death in BV2 microglial cells. To determine the cell-signalling pathways involved, we probed microglial cell lysates for changes in ERK1/2 and AKT phosphorylation, IκB degradation, and IL-6 secretion using Western blot and ELISA analysis. In summary, BV2 microglial cells secrete CypA in response to inflammatory and oxidative stress, and that rCypA increases cell viability and chemotaxis. Our findings suggest that rCypA is a pro-survival chemokine for microglia that may influence the GBM tumour microenvironment.

Can we improve dysphagia referrals?

We set out to examine whether a multidisciplinary out-patient dysphagia referral triage service would shorten the duration of a patient's referral process and direct patients to the correct specialty. A review was carried out of patients referred with dysphagia before and after the introduction of a multidisciplinary out-patient dysphagia service, from February 2001 to April 2001 and from January 2002 to March 2002, inclusive.

One hundred and eight patients were referred in total. The length of time until the first appointment was reduced from four to three weeks (median; range one to 23; p<0.001). The number of instrumental investigations was reduced, with a median of one instrumentation per patient under the new service, compared with two in those under the standard service (p<0.001). Attendance to hospital was also reduced, with 45 per cent of patients under the new service requiring only one appointment, compared with 13 per cent in those under the standard service (p<0.001).

The multidisciplinary out-patient dysphagia service was associated with significant reductions in waiting times, in the number of instrumental investigations and in the duration of the patient's referral process.

Poly-arginine-18 (R18) Confers Neuroprotection through Glutamate Receptor Modulation, Intracellular Calcium Reduction, and Preservation of Mitochondrial Function

Recent studies have highlighted that a novel class of neuroprotective peptide, known as cationic arginine-rich peptides (CARPs), have intrinsic neuroprotective properties and are particularly effective anti-excitotoxic agents. As such, the present study investigated the mechanisms underlying the anti-excitotoxic properties of CARPs, using poly-arginine-18 (R18; 18-mer of arginine) as a representative peptide. Cortical neuronal cultures subjected to glutamic acid excitotoxicity were used to assess the effects of R18 on ionotropic glutamate receptor (iGluR)-mediated intracellular calcium influx, and its ability to reduce neuronal injury from raised intracellular calcium levels after inhibition of endoplasmic reticulum calcium uptake by thapsigargin. The results indicate that R18 significantly reduces calcium influx by suppressing iGluR overactivation, and results in preservation of mitochondrial membrane potential (ΔΨm) and ATP production, and reduced ROS generation. R18 also protected cortical neurons against thapsigargin-induced neurotoxicity, which indicates that the peptide helps maintain neuronal survival when intracellular calcium levels are elevated. Taken together, these findings provide important insight into the mechanisms of action of R18, supporting its potential application as a neuroprotective therapeutic for acute and chronic neurological disorders.

Analysis of the Pharyngoesophageal Pressure Profile in Amyotrophic Lateral Sclerosis

Treatment of dysphagia resulting from bulbar amyotrophic lateral sclerosis has included cricopharyngeal myotomy for many years but is successful in only a minority of cases. The purpose of this study was to explore the rationale for this procedure with modern manometric techniques. The results of pharyngoesophageal manometry in 13 patients with amyotrophic lateral sclerosis were compared with 13 age- and sex-matched healthy volunteers by Mann-Whitney analysis. There was no significant difference between patients and control subjects in distal esophageal or lower esophageal sphincter motility nor any pressure parameter of pharyngoesophageal motility. Separate analysis of the seven significantly dysphagic subjects showed a significantly reduced upper esophageal sphincter after-contraction amplitude during water and bread swallows in patients than in control subjects. These data suggest that the dysphagia of amyotrophic lateral sclerosis is not due to upper esophageal sphincter spasm and that treatment by cricopharyngeal myotomy may be inappropriate.

Corrigendum to "Microglia are both a source and target of extracellular cyclophilin A" [Heliyon 5(9) August 2019 e02390]

[This corrects the article DOI: 10.1016/j.heliyon.2019.e02390.].

Day case tonsillectomy in adults: how many are suitable?

Day case surgery is increasing to improve health care cost efficiency. The economic benefits of day surgery depend on how many patients are suitable. Adult tonsillectomy is a common operation. This study aims to define what proportion of adults undergoing tonsillectomy are suitable for day case surgery. One hundred consecutive adults undergoing elective in-patient tonsillectomy were studied prospectively. Patients were questioned, examined and investigated for any general medical or social contra-indications to day surgery as specified by the Royal College of Surgeons of England. They were also questioned about specific contra-indications to day case tonsillectomy, including NSAID contra-indications and tonsillectomy indicated for biopsy, quinsy or with another procedure. Seventy-six per cent patients satisfied the requirements. The most common reasons for failure were social. A high proportion of adults are suitable for day case tonsillectomy and therefore significant economic benefits are possible. However, prior to such surgery further work on operation suitability is required.